After five-years of data analyses, the GENAHTO (Gender and Alcohol’s Harms to Others) project wrapped up this year after producing a broad range of critical outcomes, including 26 published studies from across the globe. As the first multinational project to assess the extend and impacts of alcohol’s secondhand harms, it provided new insights into how different social and cultural contexts and alcohol-related policies affect or mitigate such alcohol harms to others.
By studying how individual, social, and economic influences within regions and societies may affect heavy drinkers’ harms to families (including partners and children), friends, and strangers, the research informs prevention planning and alcohol policy development in varying cultural contexts.
The project was funded by the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) under grant number R01AA023870 and involves collaborators at five study sites and an international team of scientists representing 36 countries.
Data Sources
Led by ARG scientific director and senior scientist Thomas K. Greenfield, with professors Sharon Wilsnack of the University of North Dakota, School of Medicine & Health Sciences, and Kim Bloomfield of Aarhus University, Centre for Alcohol and Drug Research, Denmark, the international team assessed data that represented experiences of both victims and perpetrators in 36 countries.
The team combined surveys from 21 countries of the Gender, Alcohol and Culture: An International Study (the GENAHTO Project), including the WHO-Thai Health supported studies, and a survey conducted in the US, with survey data gathered earlier in the GENACIS project, which had involved many of the same investigators.
The countries and regions surveyed represented a wide range of alcohol policies, drinking cultures, and varied in socioeconomic conditions, including income and gender inequalities. Within a multilevel social ecological framework, the data were used to look at individual and contextual factors associated with people who experienced harms from someone else’s drinking (“victims”) and people who caused harms because of their own drinking, so called “perpetrators”. The project also assessed regional differences within and between countries that may help modify risks, including variations in drinking cultures and alcohol policies that prevent or promote secondhand harms.
Who is Affected & Types of Harms
An analysis of U.S. national survey data found 21% of women and 23% of men, an estimated 53 million adults, experienced harm because of someone else’s drinking. These harms were threats or harassment, ruined property or vandalism, physical aggression, harms related to driving, or financial or family problems (including alcohol’s harms to partners and children).
Respondents’ own heavy drinking and having a heavy drinker in the household increased risk for all types of harms. Physical aggression from others’ drinking was particularly elevated for heavy-drinking women.
Other multinational studies looked in depth at harms to children such as physical harm, neglect, and exposure to family violence due to others’ drinking and found rates differed by country. Alcohol-related harms to children were demographically widespread and greater in families with heavy drinkers with the proportion of children affected ranging from 4% to 14% of respondents, across countries.
In many countries, workers were negatively affected by a co-worker’s drinking, ranging from 1% of respondents in New Zealand to 16% in Thailand. Harms included having to work extra hours, loss of productivity, and accidents on the job.
Related Article: Alcohol Causes Significant Harm to Those Other than the Drinker
Gender Differences
The specific types of secondhand harms people experienced differed by gender. Women were more likely to report financial and family problems, and intimate partner violence, whereas men were more likely to experience physical aggression. For men, these aggressions were most often perpetrated by strangers and acquaintances, whereas women were more often harmed by intimate others such as partners and family members.
Men who experienced secondhand harms from alcohol were often perpetrated by strangers and acquaintances, whereas women’s harms were more often the result of drinking by intimate others such as partners and family members.
Other harms women experienced included negative mental health and lower quality of life. The number of women who reported having a harmful heavy drinking partner varied by country and region, ranging from 4% to 33%. A U.S. state analysis found that harmful effects of male binge drinking may be intensified by state-level gender inequality resulting in worse outcomes for women and children in the household.
Effect of Alcohol Policies
A 12-country study found that comprehensive penalties such as community service, detentions, fines, ignition interlocks, license suspension, mandatory alcohol treatment, vehicle impoundment, and penalty point systems were associated with significantly lower rates of riding with an intoxicated driver and having a vehicular crash due to someone else’s drinking.
In a US study, results showed that the restrictiveness of a state’s alcohol policy was associated with lower levels of aggression harms and reduced vehicular harms due to other drinkers, while family and financial harms from other drinkers were not linked to alcohol control policies.
Related Article: Stricter Policies Lower the Risk of Being Hurt by Someone Who’s Been Drinking
Strategies to Mitigate Harms
From the extensive scope of the GENAHTO project, the research team strongly supports a public health approach to address alcohol’s harms to others, including environmental interventions such as alcohol tax increases and reducing availability, both of which have shown to decrease excessive drinking and reduce harms to people other than the drinker.
There also needs to be a focus on preventing intimate partner violence due to alcohol use; secondhand harms experienced by women are often more extensive and far-reaching, and include negative mental health and lower quality of life. Such harms could be mitigated by broad alcohol control policies at the local and national level but may also need other prevention strategies reching the families with heavy drinkers.
Related Article: State Binge Drinking Rates Mediate the Effects of Alcohol Policies and State Living Standards
Selected Publications
Callinan, S., Karriker-Jaffe, K.J., Roberts, S.C.M., Cook, W.K., Kuntsche, S., Grittner, U., Graham, K., Room, R., Bloomfield, K., Greenfield, T.K., Wilsnack, S., (in press). A gender-focused multilevel analysis of how country, regional and individual level factors relate to harm from others’ drinking. Drug-Educ Prev Polic.
Callinan, S., Rankin, G., Room, R., Stanesby, O., Rao, G., Waleewong, O., Greenfield, T.K., Hope, A., Laslett, A.-M., (2019). Harms from a partner’s drinking: an international study on adverse effects and reduced quality of life for women. Am J Drug Alcohol Abuse 45, 170-178.
Greenfield, T.K., Cook, W.K., Karriker-Jaffe, K.J., Li, L., Room, R., (2021). Are countries’ drink-driving policies associated with harms involving another driver’s impairment? Alcohol Clin Exp Res 45, 429-435.
Greenfield, T.K., Cook, W.K., Karriker-Jaffe, K.J., Patterson, D., Kerr, W.C., Xuan, Z., Naimi, T.S., (2019). The relationship between the U.S. state alcohol policy environment and individuals’ experience of secondhand effects: alcohol harms due to others’ drinking. Alcohol Clin Exp Res 43, 1234-1243.
Grittner, U., Wilsnack, S., Kuntsche, S., Greenfield, T.K., Wilsnack, R., Kristjanson, A., Bloomfield, K., (2020). A multilevel analysis of regional and gender differences in the drinking behavior of 23 countries. Subst Use Misuse 55, 772-786.
Karriker-Jaffe, K.J., Drabble, L., Trocki, K.F., Hughes, T.L., Greenfield, T.K., (2021). Harm from others’drinking among sexual minority adults in the United States. LGBT Health 8, 50-59.
Karriker-Jaffe, K.J., Room, R., Giesbrecht, N., Greenfield, T.K., (2018). Alcohol’s harm to others: Opportunities and challenges in a public health framework. J Stu Alcohol Drugs 79, 239-243.
Karriker-Jaffe, K.J., Tam, C.C., Cook, W.K., Greenfield, T.K., Roberts, S.C.M., (2019). Gender equality, drinking cultures and second-hand harms from alcohol in the 50 US states. Int J Environ Res Public Health, 16, pii: E4619.
Laslett, A.-M., Jiang, H., Kuntsche, S., Stanesby, O., Wilsnack, S., Sundin, E., Waleewong, O., Greenfield, T.K., Graham, K., Bloomfield, K., (2020a). Cross-sectional surveys of financial harm associated with others’ drinking in 15 countries: unequal effects on women? Drug Alcohol Depend 211, 107949.
Laslett, A.-M., Stanesby, O., Graham, K., Callinan, S., Karriker-Jaffe, K.J., Wilsnack, S., Kuntsche, S., Waleewong, O., Greenfield, T.K., Gmel, G., Florenzano, R., Hettige, S., Siengsounthone, L., Wilson, I., Taft, A., Room, R., (2020b). Children’s experience of physical harms and exposure to family violence from others’ drinking in nine societies. Addict Res Theory 28, 354-364.
Laslett, A.-M., Stanesby, O., Wilsnack, S., Room, R., Greenfield, T.K., (2020c). Cross-national comparisons and correlates of harms from the drinking of people with whom you work. Alcohol Clin Exp Res 44, 141-151.
Nayak, M., B., Patterson, D., Wilsnack, S.C., Karriker-Jaffe, K.J., Greenfield, T.K., (2019). Alcohol’s secondhand harms in the United States: new data on prevalence and risk factors. J Stu Alcohol Drugs 80, 273-281.
Room, R., Callinan, S., Greenfield, T.K., Rekve, D., Waleewong, O., Stanesby, O., Thamarangsi, T., Benegal, V., Casswell, S., Florenzano, R., Hanh, H.T.M., Hettige, S., Karriker-Jaffe, K.J., Obot, I., Rao, G., Siengsounthone, L., Laslett, A.-M., (2019a). The social location of harm from others’ drinking in 10 societies. Addiction 114, 425-433.
Room, R., Greenfield, T.K., Holmes, J., Kraus, L., Livingston, M., Pennay, A., Törrönen, J., (2020). Supranational changes in drinking patterns: factors in explanatory models of substantial and parallel social change. Addict Res Theory 28, 467-473.
Room, R., Kuntsche, S., Dietze, P., Munné, M., Monteiro, M., Greenfield, T.K., (2019b). Testing consensus about situational norms on drinking: a cross-national comparison. J Stu Alcohol Drugs 80, 651-659.
Stanesby, O., Callinan, S., Graham, K., Wilson, I.M., Greenfield, T.K., Wilsnack, S., Hettige, S., Hanh, H., Ibanga, A., Siengsounthone, L., Waleewong, O., Laslett, A.-M., (2018). Harm from known others’ drinking by relationship proximity to the harmful drinker and gender: A meta-analysis across 10 countries. Alcohol Clin Exp Res 42, 1693-1703.
Stanesby, O., Gmel, G., Graham, K., Greenfield, T.K., Waleewong, O., Wilsnack, S.C., (2020). Improving measurement of harms from others’ drinking: a key informant study on type and severity of harm. Nord Stud Alcohol Dr 37, 122-140.
Tedor, M.F., Quinn, L.M., Wilsnack, S.C., Wilsnack, R.W., Greenfield, T.K., (2018a). Gender and country differences in alcohol-aggression expectancy and alcohol-related intimate partner violence. Deviant Behav, 39, 554-575.
Tedor, M.F., Quinn, L.M., Wilsnack, S.C., Wilsnack, R.W., Greenfield, T.K., (2018b). The gender difference in the association between early onset of drinking and problem drinking between the U.S. and Japan. Deviant Behav 39, 1578-1599.
Wilsnack, S.C., Greenfield, T.K., Bloomfield, K.A., (2018c). The GENAHTO Project (Gender and Alcohol’s Harm to Others): design and methods for a multinational study of alcohol’s harm to persons other than the drinker. Int J Alcohol Drug Res 7, 37-47.
